Equipment can contribute to soccer-related injures in children as well. Heavier balls have a larger diameter and higher inflation pressures. Use of an overly heavy ball reportedly causes more wrist fractures in young goalkeepers.¹⁶ The force imparted by the ball hyperextends the wrist, producing an injury that is analogous to that sustained when falling on the outstretched hand.

Strikers have a higher rate of lower leg fractures than those playing in other positions, probably due to their increased direct contact with goalkeepers and close play in the penalty area.² Reports on pediatric soccer injuries from the 1980s found that the injury rate of female players was almost twice that of their male counterparts.⁵ This is no longer believed to be the case, owing to improved training regimens and playing skills in girls.²

SPECIFIC CASES

Examples demonstrate the wide range of frequency and severity of soccer injuries.

• Anterior cruciate ligament (ACL) tears. These are the most common serious injuries in children who play soccer, and they are found more frequently in female players.^2,7,9,10,17 This type of injury generally occurs during deceleration, while landing or turning, and when there is a rotational force on the lower leg with the knee held semiflexed (Figure 3). Many reasons for the higher incidence of ACL tears in girls have been proposed, relating to differences in male and female anatomy.^2,7,17 An ACL tear can end a career in soccer, even with expert management and surgical repair.¹⁷ Long-term studies have shown that some female players have radiographically detectable osteoarthritis as early as 10 to 12 years after the trauma.^2,17,18

• Head trauma. It is important that young children are taught to head the ball correctly when learning how to play soccer to prevent injuries, including concussion.¹⁵ Balls that are too large and those that are kicked with force are more likely to cause head injuries in children. Open head wounds typically result from clashes with another player or a solid object. Dental (tooth loss) and facial injuries, contusions, fractures, and eye injuries can also result from this type of interaction.